The Japan Coma Scale (JCS) score has been widely used to assess patients’ consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients. Using the Japan Trauma Data Bank, we conducted a nationwide registry-based retrospective cohort study. Patients 16 years old or older directly transported from the trauma scene between January 2004 and December 2017 were included. Our primary outcome was in-hospital mortality. We examined outcome prediction accuracy based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis with multiple imputation. A total of 222,540 subjects were included; their in-hospital mortality rate was 7.1% (n = 15,860). The 10-point scale JCS and the total sum of Glasgow Coma Scale (GCS) scores demonstrated similar performance, in which the AUROC (95% CIs) showed 0.874 (0.871–0.878) and 0.878 (0.874–0.881), respectively. Multiple logistic regression analysis revealed that the higher the JCS score, the higher the predictability of in-hospital death. When we focused on the simple four-point scale JCS score, the adjusted odds ratio (95% confidence intervals [CIs]) were 2.31 (2.12–2.45), 4.81 (4.42–5.24), and 27.88 (25.74–30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS of 0 as a reference category. JCS score on hospital arrival after trauma would be useful for predicting in-hospital mortality, similar to the GCS score.

中文翻译：

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日本昏迷量表评分与创伤患者住院时间与住院死亡率之间的关系

日本昏迷量表（JCS）分数已被广泛用于评估日本患者的意识水平。JCS分数分为四个主要类别：警报（0）以及基于眼球反应测试的一位数，二位数和三位数代码，每个类别都有三个子类别。这项研究的目的是调查JCS评分在到达医院时在预测成人创伤患者预后中的作用。使用日本创伤数据库，我们在全国范围内进行了基于注册表的回顾性队列研究。纳入从2004年1月至2017年12月期间直接从创伤现场转运的16岁或16岁以上患者。我们的主要结局是院内死亡率。我们根据接收器工作特征曲线（AUROC）下的面积和具有多重插补的多重logistic回归分析检查了结果预测的准确性。总共包括222,540名受试者；他们的院内死亡率为7.1％（n = 15,860）。10分量表的JCS和格拉斯哥昏迷量表（GCS）总分显示出相似的表现，其中AUROC（95％CI）分别显示0.874（0.871-0.878）和0.878（0.874-0.881）。多元逻辑回归分析表明，JCS评分越高，院内死亡的可预测性越高。当我们关注简单的四点量表JCS分数时，调整后的优势比（95％置信区间[CIs]）为2.31（2.12-2.45），4.81（4.42-5.24）和27.88（25.74-30.20）。分数为一位数，两位数和三位数的组，分别以JCS为0作为参考类别。与GCS评分类似，创伤后医院到达时的JCS评分将有助于预测院内死亡率。